Perioperative and Oncologic Outcomes of Secondary Cytoreductive Surgery: A Retrospective Analysis from a Cancer Care Centre of Southern India

Background Epithelial ovarian cancer (EOC) frequently relapses despite optimal primary treatment, with platinum-sensitive disease presenting a therapeutic challenge. Secondary cytoreductive surgery (SCS) may improve outcomes in select patients, but evidence from randomized trials is mixed. This study evaluates perioperative and oncologic outcomes of SCS in platinum-sensitive relapsed EOC, comparing upfront SCS (primary surgery [PS]) versus SCS after systemic therapy (AS). Methods In this retrospective cohort study at a tertiary cancer center in Southern India (April 2017–December 2024), 47 patients with platinum-sensitive relapsed EOC meeting AGO DESKTOP III criteria (prior complete cytoreduction, ECOG 0–2, no ascites) underwent SCS. Patients were stratified into PS (n = 30) and AS (n = 17) groups. Progression-free survival (PFS) was from SCS to recurrence/death or censoring (December 31, 2024). Post-recurrence survival (PRS) was from relapse to death/censoring. Survival was analyzed using Kaplan-Meier curves, log-rank tests, and Cox models. Complications were graded by Clavien-Dindo classification. Results Groups were comparable in age (mean 50.8 years), BMI (27 kg/m²), and histology (high-grade serous: 80%). Mean platinum-free interval was 33.4 months (38 PS vs. 28 AS). Complete cytoreduction was achieved in all; hyperthermic intraperitoneal chemotherapy was used in 36.2%. Complications occurred in 34% (mostly grade 1–2); one mortality (neutropenia). Mean PFS was 21.8 months (21.4 PS vs. 20.1 AS; HR 0.98, 95% CI 0.52–1.83; P = 0.95). Mean PRS was 38 months (32.7 PS vs. 44.7 AS; HR 1.73, 95% CI 0.87–3.44; P = 0.121). Conclusions SCS yields favorable PFS and PRS in selected platinum-sensitive relapsed EOC patients, with a nonsignificant trend toward better PRS after upfront systemic therapy. Perioperative morbidity is acceptable. Prospective studies are needed to confirm benefits and refine selection criteria.